Normal Palmar Fascia
Palmar fascia is a thin fibrous layer beneath the skin.
- 0.3mm: Fascia thickness (normal baseline)
- 4: Pretendinous bands (one per finger ray)
- ~5%: Prevalence (Northern European men)
- 60s: Peak onset age (gradual progression)
Palmar fascia anatomy
Thin fibrous bands connect skin to flexor tendons.
Normal function
Anchors skin, protects tendons, stabilizes grip strength.
Risk factors
Genetics, alcohol use, diabetes, and smoking raise risk.
Nodule Formation
Myofibroblasts proliferate, forming firm nodules in the fascia.
- 3–8mm: Nodule diameter (palpable subcutaneous lump)
- Myofibroblast: Driving cell type (contractile fibroblast)
- III → I: Collagen shift (stiffer matrix forms)
- Distal palm: Common site (ring finger ray)
Myofibroblast proliferation
Fibroblasts transform into contractile myofibroblast cells.
Nodule composition
Dense collagen and cellular nodules replace healthy fascia.
Early symptoms
A palpable lump forms with no contracture yet.
Cord Development
Nodules mature into dense, longitudinal fibrous cords.
- Pretendinous: Cord types (spiral & central variants)
- High: Collagen density (Type I dominant)
- 2–4cm: Cord length (palm to finger base)
- Reduced: Vascularity (cord becomes avascular)
Cord formation
Nodules elongate into taut, rope-like fibrous cords.
Cord anatomy
Pretendinous, spiral, and central cords commonly form.
Mechanical effect
Cords resist passive finger extension under tension.
Progressive Contracture
Shortening cords pull fingers into fixed flexion.
- 0–45°: Tubiana Stage 1 (mild deformity)
- >135°: Tubiana Stage 4 (severe deformity)
- Ring finger: Most affected digit (then little finger)
- Positive: Tabletop test (hand can't lie flat)
Tubiana staging table
Grades total flexion deformity across finger joints.
MCP and PIP joints
Both joints progressively lose extension capacity.
Functional impact
Grip, hygiene, and glove-fitting all become difficult.
Needle Fasciotomy
A needle divides the cord, releasing finger extension.
- Percutaneous: Procedure (needle aponeurotomy)
- Days: Recovery time (minimal downtime)
- ~50%: Recurrence rate (within 5 years)
- Local: Anesthesia (outpatient procedure)
Procedure technique
The needle tip repeatedly punctures and divides the cord.
Immediate outcome
Finger extension improves right after cord release.
Limitations
Higher recurrence than surgery, but much faster recovery.